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Dialysis reimbursement policies poor, lead to high health care costs worldwide
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Government reimbursement for hemodialysis and PD is inadequate to treat all patients with ESKD in low- and middle-income countries and programs to prevent the progression of chronic kidney disease are globally underutilized, both of which have a high impact on public health expenditure, according to a study published in the Clinical Journal of the American Society of Nephrology.
“Our study shows that dialysis reimbursement policies in most countries are focused on conventional in-center hemodialysis, although home hemodialysis and peritoneal dialysis might contribute to improved quality of life and cost savings,” Arjan van der Tol, MD, of the department of internal medicine at Ghent University Hospital in Belgium, nephrology section, and colleagues wrote. “Nephrology professionals, scientific associations, policy makers and industry must collaborate to implement cheaper ways to provide dialysis care to patients in need of [kidney replacement therapy]. Initiatives to improve CKD care should also focus on improving access to transplantation, increasing provision of prevention strategies to reduce progression from CKD to ESKD, and improving the quality of supportive care for ESKD that does not involve dialysis.”
To compare dialysis reimbursement policies and to assess the impact on health care budgets, researchers conducted an online cross-sectional survey of the heads of nephrology divisions of university hospitals from 90 countries between July 2016 and December 2016. Using the World Bank’s gross national income per capita, countries were then classified according to income groups (low, lower-middle, upper-middle and high).
Researchers found that total government expenditure is $57.1 billion per year for the approximately 2,600,000 patients on dialysis worldwide.
In addition, there was a correlation between prevalence of hemodialysis and national gross domestic product (GDP) per capita and also between prevalence of PD use and national GDP per capita in low- and middle-income countries. This association was not observed in high-income countries.
Furthermore, government reimbursement for dialysis services uses a higher proportion of public health expenditure in low- and middle-income countries than in high-income countries.
The percentage of patients on PD was low, even in countries where PD is better reimbursed than hemodialysis, and strategies to decrease public health costs of ESKD are underutilized in all countries, according to the researchers.
“Our approach allowed [us] to compare results from all countries within the same time period, by contrast with previous studies which collected results over several decades,” the researchers wrote. “Our data represent 81% of the world population, including may different economic and health care systems. Finally, we made an approximate calculation of total government expenditure for dialysis worldwide, which provides a benchmark for analysis of future trends.”
In a related editorial, Edwina Brown, DM, FRCP, consultant nephrologist at Hammersmith Hospital, Imperial College Renal and Transplant Centre, London, wrote: “Curtailing costs of dialysis is essential to enable dialysis provision to grow over coming years. Understanding the factors impacting on the use of PD is therefore important, but it is simplistic to think that government policy or reimbursement can result in increased use without changing the culture of local health care provision or finding more economical ways of manufacturing and delivering PD fluid than exist at the moment.” – by Melissa J. Webb
Disclosures: van der Tol reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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